Healthcare Provider Details

I. General information

NPI: 1447383187
Provider Name (Legal Business Name): JESUS A RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 BANDERA RD STE 104
HELOTES TX
78023-4575
US

IV. Provider business mailing address

9179 GRISSOM RD STE 101
SAN ANTONIO TX
78251-2810
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-0161
  • Fax: 210-343-8479
Mailing address:
  • Phone: 210-680-8081
  • Fax: 210-680-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: